Avril A. Farlam

The applicant requested a reconsideration of a Tribunal decision that found her injuries fell within the Minor Injury Guidelines (MIG) and denied her claims for a treatment plan and psychological examination.

The applicant argued the Tribunal erred in fact and law and sought to introduce a new psychological assessment.

The Vice Chair dismissed the request, finding no errors in the original decision's weighing of evidence or factual findings.

The Vice Chair also rejected the new evidence, noting it could have been obtained prior to the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were limited to soft tissue strains and that she failed to prove any psychological impairment or pre-existing condition that would remove her from the MIG.

As the $3,500 MIG funding limit had already been exhausted, the disputed treatment plans were not payable.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer denied certain benefits, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG), and requested the applicant attend insurer's examinations (IEs) under s. 44 of the Schedule.

The applicant refused to attend, arguing that the Schedule does not permit an IE to determine the applicability of the MIG.

The respondent requested a preliminary issue hearing to determine if the application was barred under s. 55.

The Tribunal found that the applicant's interpretation of the Schedule was incorrect and that she was required to attend the IEs.

Because the applicant failed to attend the IEs without a reasonable explanation, she was barred from proceeding with her application.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans for physiotherapy, Botox, and chronic pain.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the disputed benefits were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors and the applicant's treating neurologist, which did not support the proposed treatments.

Claims for a special award and interest were also dismissed as no benefits were payable and there was no evidence of unreasonable delay.

The applicant sought non-earner benefits, attendant care benefits, and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as her self-reported activities and the medical evidence indicated she had resumed many pre-accident activities.

The Tribunal also denied attendant care benefits, finding they were not reasonable, necessary, or incurred.

Claims for physiotherapy and assistive devices were dismissed for lack of supporting medical evidence.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits, claiming he suffered physical and psychological injuries when he jumped out of the way of a reversing vehicle.

The respondent denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant's alleged injuries did not arise out of the ordinary use or operation of an automobile, failing the purpose test.

The medical evidence showed significant pre-existing conditions and no contemporaneous reports of injury, undermining the applicant's credibility.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

At the commencement of the hearing, the applicant brought a preliminary motion arguing that the respondent failed to provide denial letters for five treatment plans in accordance with s. 38 of the Schedule, and therefore the hearing should proceed only on the issue of a special award.

The Tribunal dismissed the motion, finding that whether the denial letters were sent was a fundamental factual dispute requiring evidence from both parties.

During the hearing, the parties reached a settlement in principle, and the Tribunal adjourned the matter to allow the parties to finalize the settlement and file a Notice of Withdrawal.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued that pre-existing shoulder and psychological issues, along with accident-related chronic pain and psychological impairment, removed him from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting inconsistencies between the applicant's self-reports, his family physician's records, and the insurer's examinations.

The Tribunal concluded the injuries were predominantly minor and subject to the MIG limit, which the respondent had already substantially paid.

The disputed treatment plans were therefore not payable.

The appellant's vehicle was impounded after being driven by an individual with a suspended licence.

The appellant filed an appeal of the impoundment approximately 20 days after the 15-day statutory deadline had expired.

The appellant brought a motion for an extension of time to file the appeal.

The Licence Appeal Tribunal applied the four-part test for extending time and found that the appellant lacked a bona fide intention to appeal within the time limit, the delay was significant, the respondent would suffer prejudice, and the merits of the appeal were weak.

The motion for an extension of time was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied non-earner benefits and certain treatment plans.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly soft tissue injuries falling within the MIG, and she failed to prove that pre-existing conditions, chronic pain, or psychological injuries warranted removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life, as she continued to perform many pre-accident activities.

The disputed chiropractic treatment plans were deemed not reasonable and necessary, and claims for a special award and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for a $2,738.00 medical benefit for chiropractic services.

The applicant argued the Tribunal failed to consider important medical evidence and erred in fact by suggesting chiropractic treatment was not recommended.

The Vice Chair found no errors of law or fact in the original decision, noting the adjudicator properly considered and weighed the medical evidence.

The request for reconsideration was dismissed.

The applicant insurer sought a preliminary determination of whether the respondent was involved in an 'accident' as defined in s. 3(1) of the Statutory Accident Benefits Schedule.

The respondent suffered paraplegia when an inoperable vehicle he was helping to load onto a trailer fell and pinned him.

The Tribunal found that the incident did not meet the purpose test, as the vehicle was not roadworthy and could not move under its own power, meaning the injuries did not arise out of the ordinary use or operation of the vehicle.

Consequently, the Tribunal concluded that the respondent was not involved in an accident relating to the vehicle insured by the applicant.

The applicant requested a reconsideration of a decision that found she was not entitled to statutory accident benefits because she was not living in Ontario at the time of the accident and was not insured under an Ontario motor vehicle policy.

The applicant argued the Tribunal acted outside its jurisdiction and made errors of law and fact.

The Tribunal dismissed the reconsideration request, finding no errors of law or fact and concluding that the applicant was attempting to reargue her case.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's impairments were caused by a subsequent disc herniation rather than the accident.

The Tribunal found that the applicant's physical injuries from the accident were soft tissue injuries that had substantially healed before the disc herniation occurred.

The Tribunal preferred the evidence of the respondent's orthopaedic surgeon over the applicant's experts, concluding the applicant failed to prove on a balance of probabilities that his physical or psychological impairments were caused by the accident.

The application was dismissed, with no entitlement to benefits, an award, or interest.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer denied the benefits pending receipt of further medical information.

The applicant brought a preliminary issue hearing arguing the insurer failed to comply with the 10-day response requirement under section 36 of the Statutory Accident Benefits Schedule and should therefore be ordered to pay the benefits pending the substantive hearing.

The Tribunal found the insurer responded within the required timeframe and reasonably requested further information under section 33.

The preliminary issue was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and sought repayment of $7,120 for overpaid Income Replacement Benefits (IRB).

The Tribunal found the applicant's physical injuries were soft tissue in nature and that he failed to prove chronic pain or psychological injuries warranting removal from the MIG.

Furthermore, the Tribunal ordered the applicant to repay the $7,120 in IRBs, finding he wilfully misrepresented his work status by continuing to collect benefits after returning to work.

The application for additional treatment plans and a special award was dismissed.

The applicant was involved in a motor vehicle accident and received income replacement benefits (IRB) from the respondent insurer.

The respondent sought repayment of $9,028.00 in IRB, alleging the applicant had returned to work as a taxi driver and wilfully misrepresented his employment status.

The applicant also sought payment for a chiropractic treatment plan.

The Tribunal found that surveillance evidence and the applicant's own admissions established he had returned to work and failed to disclose this to the insurer, his doctors, or his legal representative.

Consequently, the Tribunal ordered the applicant to repay the IRB with interest.

The Tribunal also dismissed the applicant's claim for the chiropractic treatment plan, finding insufficient evidence that it was reasonable and necessary.

The applicant sought a special award under s. 10 of Regulation 664, alleging the respondent unreasonably delayed payment of an income replacement benefit previously ordered by the Tribunal.

The respondent had attempted to send the payment multiple times but repeatedly mailed it to incorrect addresses due to administrative errors.

The Tribunal found that while the respondent's actions indicated a lack of competence, they did not rise to the level of unreasonableness required for a special award.

The request for an award was dismissed, but the applicant was granted interest on the overdue payment pursuant to s. 51 of the Schedule.

The applicant sought non-earner benefits and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant was barred from claiming non-earner benefits because she failed to submit a completed disability certificate supporting her claim, as required by s. 36(2) of the Schedule.

Furthermore, the Tribunal found that the applicant failed to establish that she suffered a complete inability to carry on a normal life, noting that her pre-accident medical records contradicted her testimony regarding her pre-accident activity levels.

The claim for a psychological pre-screening assessment was also dismissed as not reasonable and necessary, and no award or costs were granted.

The applicant sought income replacement benefits following a 2013 motor vehicle accident.

The respondent insurer denied the benefits in March 2014 after the applicant returned to work.

The applicant stopped working in 2015 but did not file an application with the Tribunal until November 2019.

The Tribunal found the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule, as it was commenced more than two years after the clear and unequivocal denial.

The Tribunal also declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the limitation period, excessive delay, prejudice to the respondent, and lack of merit.